We all need to flush

Diarrhoea kills more children than Aids or malaria. But clean water supplies are only part of the so

Diarrhoea. The runs. The squits. The “insert funny name here”. Diarrhoea is funny, right? Because diarrhoea is something that you get from a bad kebab or some dodgy prawns. Because it is curable; not fatal; benign. It can be all those things, but only if your surroundings are not continually contaminated with the faecal particles that probably gave you the diarrhoea in the first place. Four in ten people in the world (2.6 billion) live with no sanitation whatsoever. When there’s no good containment – a toilet, or a pit latrine will do – faecal particles will be tramped on by people’s feet and carried on their fingers into food and water, with horrible consequences. Diarrhoea is the second biggest killer of children under five in the world. It kills more children than HIV/Aids or malaria. A child dies of those banal squits every 15 seconds.

So it is good news that the World Health Organisation this month recommended that vaccines for rotavirus be standard for children in the developing world. Rotavirus does not cause all diarr­hoea, but it causes a lot of it. Instead of a single vaccine dose, however, harried nurses may have to give several, as diarrhoea makes it difficult for a child to retain anything. Diarrhoea is the reason you can have a malnourished child in a well-fed family. Because human faeces can carry 50 ­­­­com­municable diseases, they are an efficient weapon of mass destruction. Half of the hospital beds in sub-Saharan Africa are filled with people ­suffering from what are generally known as ­water-related diseases. Actually, they’re shit-­related diseases.
A couple of years ago, readers of the British Medical Journal voted the toilet the best medical advance of the past 200 years, over penicillin and the pill. They knew that before the flush toilet became the norm in the 19th century, one in two children in London died before the age of five. With toilets, sewers and hand-washing with soap, child mortality dropped dramatically. ­Today, we in the developed world take these things for granted. We do not give much thought to the women who must get up at 4am in darkness, trek to a nearby bush or field, and try to do their business risking rape and snakebites. It can be easy to ignore, even when you live among it.

I have met countless Indians, who live in a country where 700 million people have no choice but to do open defecation, who claim never to have seen anyone toileting in public. Yet visit any Indian – or Indonesian, or Vietnamese, or Malawian – village, and along the roads you will see men and women, elderly and young, squatting by the roadside, the women trying and failing to keep both their faces and backsides covered for modesty’s sake. “Before, they would have been jumping up at every passing car,” my Indian companion told me. “Now there’s too much traffic. They’d be up and down like a yo-yo.”

Open defecation, and its concomitant diseases, is not just unpleasant. It also costs the world a fortune. Last year, the World Bank calculated that poor sanitation cost Cambodia, Indonesia, the Philippines and Vietnam between 1.4 and 7.2 per cent of GDP (not to mention the girls who do not go to school because there is no private latrine; or the mothers who cannot work because they are trekking into the bushes for ­privacy). Yet sanitation is the most cost-effective disease prevention tool we have. The World Bank economist Guy Hutton has estimated that investing $1 in sanitation saves $7 in healthcare costs and labour days that aren’t lost. When Peru had a cholera outbreak in 1991, losses from tourism and agricultural revenue were three times greater than the total money spent on sanitation in the previous decade.

Yet, as Fatal Neglect, a recent report by WaterAid demonstrated, money continues to flow towards more fashionable diseases and causes. In Madagascar, for example, 0.1 per cent of the population has HIV/Aids, and UNAids found there were too few Aids deaths to estimate. Yet HIV/Aids receives five times more funding than sanitation, though diarrhoea kills 14,000 Madagascan children every year. Antiretroviral therapies, the most common prevention tool against Aids, costs $922 per Daly (Disability-Adjusted Life Year, a standard health-prevention unit of calculation). Sanitation and hygiene promotion costs $11 and $3 respectively. By any measure, sanitation is a bargain.

Sanitation activists do not just look wistfully at the money flowing into HIV/Aids. They also see funds gushing into clean water supplies, an easier cause to sell and publicise. Water and sanitation budgets are usually a pittance (often 0.1 per cent of GDP), and of that, 90 per cent goes on clean water supplies. I have lost count of how many celebrities have put their names to clean water charities, happily photographed in front of a bright, shiny new tap, preferably with a ­photogenic child nearby. A laudable cause, but a clean water supply reduces disease by 20 per cent, while a latrine can reduce it by 40 per cent.

In a slum not far from Calcutta, I met Sandya Barui. She was 60 (and looked 80), but had dug her own latrine pit and built her own superstructure from spare tin and banana leaves. Before that, she had had to do her business in the ban­ana fields behind her home, and it was “sinful”. Children would come and look at you as you squatted, she said. And she was spending 100 rupees ($2.50) a month on medicine, which was 100 rupees more than she had.

Then some visitors came to the slum and asked for a tour, and at the end they asked to see where people went for open defecation. Such shame! Then they asked people to estimate how many truck-loads of shit they were leaving in the open. It was a shock, Sandya said – as it was when people noticed that a plate of excrement had been brought to the meeting place and the flies were hopping merrily from the shit to the plate of chapattis next to it.

Children immediately ran off and began digging, but Sandya’s was one of the first proper ­lat­rines to be built. She spent 700 rupees on it, and thinks it is worth every paise. Diarrhoea rates in the area have dropped dramatically, and more children are going to school (studies have shown that latrines can increase school attendance, particularly among girls, by up to 20 per cent).

Sandya has done her sums. She knows that good sanitation adds up. If only the politicians holding the purse strings could figure it out too.

Rose George’s book “The Big Necessity: Adventures in the World of Human Waste” is published by Portobello Books (£12.99)

This article first appeared in the 29 June 2009 issue of the New Statesman, The Great Escape

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An English hero for the ages: Ian Botham at 60

Botham blends his sportsmanship and deep-seated passion for cricket with a lust for life.

Begging W H Auden’s pardon, it is possible both to honour and to value the vertical man, and in the case of Ian Botham, who turned 60 on 24 November, it is our bounden duty. No sportsman has given Britons so much to enjoy in the past half-century and no sportsman is loved more. Two decades after he retired from first-class cricket, his reputation as one of life’s champions remains unassailable.

No mere cricketer is he, either. Botham is a philanthropist, having raised more than £12m for various charities, notably Leukaemia and Lymphoma Research. In December, 30 years after his first walk from John o’Groats to Land’s End, he will set off again, in South Africa, where England are on tour. And he really does walk, too, not amble. As somebody who accompanied him on one of his dozen walks said: “You can’t keep up with him. The man is a phenomenon.”

Of all postwar sportsmen, only Bobby Charlton and, at a pinch, Henry Cooper come close to matching Botham’s enduring popularity. But Charlton, a shy man who was scarred by the Munich plane crash of 1958 (and may never have recovered from its emotional effects), has never comfortably occupied a public stage; and Cooper, being a boxer, had a solitary role. Botham, by contrast, spoke for England. Whenever he picked up his bat, or had a ball in his hand, he left spectators in no doubt.

Others have also spoken for England. Bobby Moore and Martin Johnson, captains respectively of England’s World Cup-winning football and rugby teams, were great players but did not reach out to people as naturally as Botham. Nick Faldo, Lester Piggott, Sebastian Coe and, to bring us up to date, Lewis Hamilton have beaten the best in the world, but they lacked those qualities that Botham displayed so freely. That is not to mark them down. They were, and are, champions. But Botham was born under a different star.

It was John Arlott, the great cricket commentator, who first spotted his uniqueness. Covering a match at Taunton in 1974, he asked the young colt to carry his bags up the rickety staircase to the press box, where Arlott, wearing his oenophile’s hat, pulled out a bottle of red wine and invited Botham to drink. Forty years later Botham is a discriminating wine drinker – and maker. Along with his friend and fellow England great Bob Willis, and their Australian wine­making pal Geoff Merrill, he has put his name to a notable Shiraz, “BMW”.

Arlott, with his nose for talent and good company, saw something in the young Botham that Brian Close, his captain at Somerset, was beginning to bring out. Later, Mike Brearley, as England captain, drew out something even more remarkable. As Rodgers and Hammerstein wrote, you’ve got to be carefully taught. And Botham, a fine team man as well as a supreme individual performer, has never withheld praise from those who enabled him to find his voice.

If sport reveals character, then cricket is the game that reveals it most clearly. In no other sport is the individual performance rooted so firmly in a team context. Every over brings a contest of skill and intelligence between batsman and bowler but only a team can win the match. “A cricketer,” as Arlott said, “is showing you something of himself all the time.”

Cricket also reveals national character more than any other sport. Football may be the most popular game in the world but cricket, and cricketers, tell us far more about England and Englishness. It is instructive, in this regard, to hear what Philippe Auclair, a French journalist and author long resident in London, has to say about Botham: “He is essentially an 18th-century Englishman.” In one! It’s not difficult to sense a kinship with Tom Jones, Fielding’s embodiment of 18th-century life, who began his journey, as readers may recall, in Somerset.

A country boy who played for Worcestershire after leaving Somerset, and who lives by choice in North Yorkshire, Botham is an old-fashioned Englishman. Although nobody has yet found him listening to the parson’s sermon, he is conservative with a small and upper-case C, a robust monarchist, handy with rod and gun, and happiest with a beaker in front of him. He represents (though he would never claim to be a representative) all those people who understand instinctively what England means, not in a narrow way, but through something that is in the blood.

Above all, he will be remembered for ever as the hero of 1981. Even now it takes some believing that Botham bowled and batted with such striking success that the Australians, who were one up after two Tests, were crushed. Some of us who were actually at Headingley for the famous third Test – thousands who claim to have been there were not – recall the odds of 500-1 on an England victory going up on the electronic scoreboard that Saturday evening.

Botham made 149 not out as England, following on, beat the Aussies by 18 runs. For three hours the country seemed to stop. In the next Test, at Edgbaston, Botham took five wickets for one run as Australia fell under his spell. Then, at Old Trafford, on a dank Saturday afternoon, he played the most memorable innings of his life and one of the greatest innings ever played by an Englishman: 118 magnificent, joyful runs. Joy: that’s the word. Botham brought joy into people’s lives.

Yet it was the final Test at the Oval, which ended in a draw, that brought from him a performance no less remarkable than those from before. He bowled 89 overs in that match, flat out, continuing to run in when others withdrew with injury. That was the team man coming to the fore. Little wonder his comrades thought the world of him.

Modest, loyal, respectful to opponents, grateful to all who have lent him a hand, and supported throughout a turbulent life by Kath, his rock of a wife, and their three children, this is a cricketing hero to rank with W G Grace, Jack Hobbs, Wally Hammond and Fred Trueman. A feature in the lives of all who saw him, and a very English hero. 

This article first appeared in the 26 November 2015 issue of the New Statesman, Terror vs the State